President Donald Trump said on Monday that sky-high Obamacare deductibles ensure that the insurance plans are "practically not even useable" for those who have them, a claim health care experts said is a misleading one because it ignores a core tenant of the law.
The president's claim, and his exhortation for Congress to pass new health care legislation, comes days after a federal judge in Texas ruled the Affordable Care Act unconstitutional. The decision is expected to be appealed to the Supreme Court, but for now, Obamacare remains the law of the land, and open enrollment is still ongoing in a handful of states.
Let's look at the facts behind this latest assertion.
Deductibles are high across the board, experts say
High deductibles aren't just an Obamacare problem, Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University's Health Policy Institute, said. They're an American insurance problem — something Trump leaves out of his Monday tweet.
In the U.S., health insurance splits the cost of care between the insurer and consumers, using monthly premiums, copays, co-insurance, and deductibles to divvy up costs. The deductible is the set amount that consumers must pay before an insurer starts paying for care, and they make up a sizable share of consumers' out of pocket health care costs.
Plans with higher premiums typically have lower deductibles, and vice versa.
"As a consumer, you make a trade-off: lower premium, higher deductible," Corlette said.
Employer-sponsored insurance plans — which insure most Americans — increasingly have high deductibles, too, according to research by the Kaiser Family Foundation.
Health care is really expensive in the U.S., and Americans' out of pocket costs — including deductibles — are considerable, experts said. It's why there are so many subsidies andcost-sharing reductions baked into Obamacare, which help make the insurance plans more affordable for lower-income Americans.
How did Obamacare change what people paid?
Trump's claim also ignores a core tenant of the ACA, which requires all plans cover a long list of preventative care services, including colonoscopies, mammograms, well-woman visits, disease screening, vaccines, and more, at no additional cost to consumers.
Insurance plans before Obamacare often obscured the real cost of each health care plan because it wasn't clear what was covered and how exactly costs would be shared, according to Dr. Daniel Derksen, a professor and associate vice president at the University Arizona who helped write part of the health care law.
The ACA mandated what must be covered, and made the cost-sharing formulas more clear and comparable.
Plans sold on Obamacare's individual marketplace are sold with with varying monthly costs and deductibles —bronze, silver, gold, and platinum plans — which experts say help consumers choose the plan right for their health care needs.
For example, an individual in Brooklyn N.Y. shopping for 2019 insurance could buy a platinum plan for $847.95 a month for a plan with no deductible and out of pocket costs capped at $2,000 for the year, or they could choose a $420.55 a month bronze plan with a $4,000 deductible and all out of pocket costs capped at $7,600 for the year.
Those costs are high, but they could be worse, Corlette said.
"Before the Affordable Care Act, you could find high deductible plans at $10,000 and even $15,000 plans," Corlette said.
The health care law also wrote an annual cap for consumers' out-of-pocket health care costs — including deductibles — into law for everyone. Next year, that cap is $7,900 on in-network health care.
Would costs go down if Obamacare is thrown out by the courts?
"No, quite the opposite. It's probable that costs would go up for a number of reasons," Corlette said.
Should Obamacare be struck down in a Supreme Court ruling, premiums might go down for younger, healthier consumers, but go up for older, healthier consumers — if they could get coverage at all. Insurance companies would likely return to denying coverage for people with pre-existing conditions.
In the short term, both Corlette and Derksen said efforts to undermine the health care law — including Republicans' removal of a tax penalty for people without insurance and lawsuits targeting the Affordable Care Act — are likely to raise the costs of plans purchased through the law's individual marketplace.
Obamacare is rooted in the principle that if more people are insured, health care costs go down. Insurance companies can more easily stay in business with more healthy people helping to cover the cost and risks of insuring sick people, and service providers wouldn't have unpaid bills driving their prices up, Derksen said.
"It's estimated that if we went back to the days of 50 million uninsured, that the premium for a family of four would rise $1,500 dollars a year," he said.